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Tired-Looking Eyes? Here’s What to Do…

Posted April 16, 2023 in Board Certification, Eyelid Surgery, From the Desk of Dr. Stoeckel, Plastic Surgery Advice, Surgical Procedures

The following is a blog written by our Board-Certified Plastic Surgeon, Dr. Stoeckel! Read on to hear more about one of our popular procedures: Blepharoplasty.

Why Do My Eyes Look So Tired? And What Can I Do About It?

The eyes are a focal point of the face. If someone is looking at you, they are likely looking at your eyes. At least, most of the time. And the eyes can show a lot. They can convey excitement, interest, surprise, contentment, and joy. Unfortunately, they can also convey disinterest, boredom, and fatigue. Even worse, sometimes they can convey the negative emotions even when we aren’t feeling negative.

As we age, a few not so nice things can happen to the eyes and eyelids. In the upper lids, the skin can stretch and lose its elasticity. When it does so, the skin can look redundant and heavy and can even encroach upon the upper eyelashes. The heavy skin can make the lid look heavy which gives the allusion of fatigue. Most people attribute alertness with the “eyes wide open” appearance which can be difficult to produce if the lid is weighed down with excess skin.

So, what can be done for the Upper Lids?

Fortunately, a cure for the “fatigued” upper lid is about as easy as things get in plastic surgery. The procedure can be completed using local anesthesia in most cases. The surgery is almost as simple as just removing the obvious excess skin after injecting some local anesthesia. Don’t get me wrong. The surgery does take some finesse and there are subtle maneuvers to be made to avoid pitfalls, but overall, the surgery is quick, has an almost invisible scar, and is associated with minimal downtime.  And for many patients, it can really make an instant difference in not only how they look, but sometimes how they see. If the excess skin before surgery is enough, it can even affect peripheral vision. Removing the excess skin might open the aperture of the lid to allow in more light and remove obstructions from the upper visual fields making vision actually better.

But what is the down time? For real?

I always must preface an answer to this kind of question with “every patient is different and will have their own recovery,” which is very true. But there is an average recovery. And the average recovery for upper lid surgery is not that big of a deal. Most people don’t even have significant bruising, but rather just a limited amount directly along the incision lines that are hidden in the lid crease. There is some swelling in the first day or two after surgery, but it is not usually significant unless you fall asleep laying face down after the procedure. The pain for most people is controlled with ibuprofen or Tylenol. The stitches are removed in 5-7 days and most patients would look very presentable at a public function 2 weeks after surgery.

It sounds like the upper lids are a breeze, but my issues are with the dark circles and lower lid eye bags. Why do my lower lids look so tired?

The puffiness of the lower lids is typically caused by a combination of issues. Sometimes there is just a little too much fatty tissue volume within the lid in a space just behind a curtain of tissue called the orbital septum. When we are young, the orbital septum “curtain” is tight and strong and able to effectively hold back the orbital fat that the globe of the eye rests upon. As we age, the curtain loses some of its strength and starts to allow the fatty tissue to push into it and move it forward. That pushing forward of the curtain by the fat is what usually causes the lower lid “bags”. It is the bags of the eyes and sometimes the excess skin of the lower lids that usually makes people appear to have tired eyes. The diagram on the left shows a tight orbital septum and the right shows a weak and bulging septum.

So, what can be done for the Lower Lids?

The orbital septum curtain can be identified and opened during lower lid surgery. Once opened, the excess orbital fatty tissue can be removed and most often repositioned to make the eyelid look smoother. Usually some of the fat is removed completely and some of the fat is placed into the tear trough which is a small hollow along the interface of the nasal sidewall and the inside portion of the lower lid. This part of the surgery is typically done using an incision on the inside of the eyelid called the conjunctiva. The manipulation and removal of fat can be done in the space behind the muscle of the eye called the orbicularis oculi. I try to minimize irritation of this muscle during surgery so that the swelling and recovery time is less. But if skin still needs to be removed, it can be excised using another incision just below the lashes on the front of the eyelid. This scar is also very well hidden.

What do I need to do to recover the fastest?

Most of the variation to how people recover is based on genetics. But there may be a few things that you can do to optimize your chances of a quick recovery with the least amount of bruising and swelling.

1. You can apply a cold compress or ice to the eyes for the first evening after surgery. Ice should never be applied directly to the skin, but ice in a bag wrapped with a moist washcloth is fine. It could be a bag of peas from the freezer or an actual eye mask that is made specifically for the occasion. They can be purchased on Amazon for a few dollars, but a bag of peas works about the same.

  1. Keep your heart rate and blood pressure normal for the first few days after surgery. Try to keep the head very slightly elevated when sleeping and avoid getting too much blood flow to the face.
  2. I am not sure where I stand on topical and oral agents that claim to minimize swelling and bruising after surgery. But it is possible that they may help some. Arnica Montana and bromelain which is found in pineapple juice have been used to try to optimize the healing process. And there are several recovery balms and soothing agents that many of the skin care lines have to offer that might have some benefits.
How natural are the results? I don’t want to look operated on and weird.

We perform quite a few eyelid surgeries on patients from Raleigh, Cary, Charlotte, and Wilmington. The results are natural, and the scars are very well tolerated.

Examples of before and after photos can be found by clicking on the following link:

Eyelid Surgery – Raleigh, NC | Dr. William Stoeckel (

Wake Plastic Surgery and Dr. Stoeckel serves Cary, Raleigh, Apex, and surrounding areas in North Carolina.